Modern Approaches in Dry Eye Diagnosis

The diagnosis of dry eye is made by carefully listening to the patient’s complaints, a comprehensive eye examination, and the combination of various specialized tests. Dr. Semrin Timlioğlu utilizes both traditional and the most current technological methods to reach the correct diagnosis. The TFOS DEWS II report offers an important guide on the steps to follow in the diagnostic process. This systematic approach increases diagnostic accuracy and enables the creation of more targeted treatment plans. Patients knowing that the diagnosis is based on a comprehensive evaluation process, not just a single test, can increase their confidence in the treatment.

Detailed Eye Examination and Patient History

The diagnostic process begins with a detailed inquiry into the patient’s general health status, medications used (prescription and over-the-counter), lifestyle, environmental factors such as work and home environment, and symptoms (when they started, how frequent they are, what makes them worse or better). Examination of the eyelids, eyelashes, Meibomian gland orifices, and conjunctiva with a special microscope called a biomicroscope is a standard procedure. The blinking pattern and frequency are also evaluated.

Standardized questionnaires such as the Ocular Surface Disease Index (OSDI) or DEQ-5 (Dry Eye Questionnaire-5) can be used to objectively assess the severity of symptoms and their impact on the quality of life. These questionnaires are also valuable for comparing the condition before and after treatment. According to the TFOS DEWS II diagnostic algorithm, an OSDI score of 13 or higher, or a DEQ-5 score of 6 or higher, increases suspicion of dry eye and necessitates further testing.

Tests to Measure Tear Quality and Quantity

Following the patient history and basic examination, various tests are applied to assess the quantity and quality of tears:

• Schirmer Test: Used to measure the amount of tear production. A special, thin filter paper is placed on the outer part of the lower eyelid, and the amount it wets in millimeters is measured over 5 minutes. While wetting more than 10 mm is generally considered normal, less than 5 mm is an important finding supporting dry eye. The test can be performed after applying topical anesthetic drops (Schirmer II or basal secretion test, which measures only basal tear production) or without anesthesia (Schirmer I, which measures both basal and reflex tear production).
• Tear Break-up Time (TBUT): Assesses the stability of the tear film, meaning how long it can maintain its integrity on the eye surface. After instilling a yellow-orange dye called fluorescein into the eye, the patient is asked to keep the eye open without blinking. Under blue light with a biomicroscope, the time in seconds until the first dry spot (break-up) forms in the tear film is measured. A TBUT value below 10 seconds indicates that the tear film is evaporating rapidly or is unstable and is considered pathological for dry eye. Non-invasive tear break-up time (NIBUT) tests, performed without fluorescein, may be preferred as they do not affect the tear film.
• Ocular Surface Staining Tests: Special dyes are used to visualize damaged or dead cells and dry areas on the cornea and conjunctiva surface.
  • Fluorescein Staining: Shows epithelial cell damage, abrasions, or dry spots on the cornea by staining them bright green. Staining of more than 5 corneal points is considered significant.
  • Lissamine Green or Rose Bengal Staining: These dyes stain devitalized or damaged conjunctival cells and mucus filaments. Lissamine Green generally causes less discomfort than Rose Bengal. Staining of more than 9 conjunctival points or staining of the eyelid margin over a specific width and length supports the diagnosis of dry eye.

Advanced Diagnostic Methods: Osmolarity, MMP-9, and Meibomian Gland Imaging

In addition to traditional tests, advanced diagnostic methods that provide more objective and targeted information in the diagnosis and management of dry eye are available:

• Tear Osmolarity Test: Measures the total concentration of dissolved particles (primarily the saltiness) in the tears. In dry eye, due to reduced tear volume or increased evaporation, the tears become more concentrated, and osmolarity increases (hyperosmolarity). Normal tear osmolarity is generally in the range of 270-308 mOsm/L. A value above 308 mOsm/L in one eye or a difference greater than 8 mOsm/L between the two eyes suggests tear film instability and dry eye disease. The osmolarity test can also be used to determine disease severity and monitor treatment effectiveness.
• MMP-9 (Matrix Metalloproteinase-9) Test: MMP-9 is an enzyme that is a marker of inflammation on the eye surface. In dry eye patients, especially if there is an inflammatory component, MMP-9 levels in the tears may increase. The MMP-9 level can be measured from a small tear sample using rapid in-office tests like InflammaDry. A positive result (i.e., high MMP-9 level) suggests that the patient may benefit from anti-inflammatory treatment (e.g., drops with corticosteroids or cyclosporine).
• Meibomian Gland Imaging (Meibography): With specialized devices like LipiScan, the structure (morphology), length, possible blockages, dilations, or loss (atrophy) of the Meibomian glands in the eyelids can be directly visualized. This is a very valuable method, particularly in the diagnosis and determination of the severity of evaporative dry eye and MGD.

The use of biomarkers like tear osmolarity and MMP-9 is an important step in dry eye management. These tests not only help diagnose but also allow for personalizing treatment selection and objectively monitoring treatment effectiveness. For instance, a high MMP-9 level indicates that inflammation is dominant and an anti-inflammatory treatment should be prioritized. High osmolarity confirms tear film instability, and the goal of treatment can be to reduce this value. This represents a shift towards a more personalized treatment strategy that targets the underlying pathophysiology, rather than solely a symptom-based approach.

Dry Eye Treatment Options: Step by Step Towards Improvement

There is no “one-size-fits-all solution” for dry eye treatment. Treatment is personalized based on the type of disease (aqueous deficient, evaporative, or mixed), its severity, underlying causes, and the patient’s individual needs and lifestyle. The DEWS II report published by The International Tear Film and Ocular Surface Society (TFOS) recommends a step-wise approach to treatment. Dr. Semrin Timlioğlu will create the most suitable treatment plan for you by following these current guidelines.

Step 1: Lifestyle Changes and At-Home Care Recommendations

The first and basic step of treatment is educating the patient about their condition and making certain lifestyle changes. While these steps may seem simple, they are extremely important in dry eye management and can provide significant relief in symptoms when applied regularly. These measures generally require a long-term commitment, especially in the management of chronic conditions like MGD, and can increase the success of more advanced treatments.

• Patient Education and Awareness: It is important to receive detailed information from your doctor about what dry eye is, potential triggers in your specific case (environmental factors, medications used, dietary habits, contact lens use, etc.), and general management strategies.
• Environmental Adjustments:
  • Increase the humidity of your environment. Heaters in winter and air conditioners in summer particularly dry out the air. You can use humidifiers or place a wet towel on radiators.
  • Avoid direct blowing from air conditioners, fans, or ventilation. When driving, do not direct the ventilation directly onto your face.
  • Absolutely avoid environments with cigarette smoke and consider quitting smoking if you use it.
• Screen Usage Habits:
  • Apply the “20-20-20 rule”: Every 20 minutes, look at a point 20 feet (approximately 6 meters) away for at least 20 seconds. This rests your eye muscles and encourages blinking.
  • Place your computer screen slightly below eye level. This can narrow your eyelid aperture, reducing evaporation.
  • Adjust screen brightness according to ambient light and consider using screen filters that reduce reflections.
  • Consciously try to blink more frequently when working in front of a screen. While you normally blink 15-20 times per minute, this number can drop to 3-5 in front of a screen.
• Eyelid Hygiene and Warm Compresses: This is very important, especially for people with Meibomian Gland Dysfunction (MGD).
  • Warm Compresses: Dip a clean cloth or a special eye mask in warm water (at a temperature that won’t burn) and wring it out, then apply it over your closed eyelids for 5-10 minutes. This helps soften the solidified oil (meibum) in the Meibomian glands and increases its fluidity. This can be repeated 1-2 times a day.
  • Eyelid Massage: After the warm compress, you can gently massage your eyelids (towards the base of the lashes) with your fingertips or a special tool to help expel the softened meibum from the gland channels. Your doctor will show you the correct massage technique.
  • Eyelid Cleaning: Regularly cleaning the base of the lashes and the eyelid margins prevents bacterial buildup, scaling, and blockage of the gland orifices. Diluted baby shampoo or special eyelid cleaning solutions or wipes manufactured for this purpose can be used.
• Nutrition and Fluid Intake:
  • Drink at least 8-10 glasses (approximately 2-2.5 liters) of water daily. Sufficient fluid intake is important for tear production as well as general body health.
  • Adopt a diet rich in Omega-3 fatty acids or use supplements after consulting your doctor. Fatty fish like salmon, mackerel, and sardines, flaxseed, chia seeds, and walnuts are good sources of Omega-3. Omega-3s can help improve tear quality and reduce inflammation on the eye surface.
  • Consume sufficient amounts of foods containing Vitamin A (carrots, spinach, sweet potatoes, egg yolks) and Vitamin B2 (dairy products, meat, green leafy vegetables).
• Protecting the Eyes: Wear wide-brimmed hats and UV-protected sunglasses or protective eyewear when going outdoors in windy, sunny, or dusty environments.
• Sleep Schedule: Getting adequate and regular sleep helps the eyes rest and regenerate, which can positively affect tear secretion.

The success of these initial step treatments largely depends on how regularly and correctly the patient adheres to these recommendations. Maintaining close communication with your doctor and making these steps a part of your lifestyle is critically important for long-term relief.

Step 2: Over-the-Counter and Prescription Drug Treatments (TFOS DEWS II Step 2)

When lifestyle changes and at-home care methods are insufficient or in the presence of moderate dry eye, various drug treatments come into play.

Artificial Tears, Gels, and Ointments

Artificial tears are the most common first-step treatment method used to alleviate dry eye symptoms. Their goal is to mimic natural tears to moisten, lubricate the eye surface, and provide temporary relief.

• Types: There are a wide variety of artificial tear products on the market:
  • Viscosity: They can be of low, moderate, or high viscosity (thickness). More fluid ones are suitable for use during the day, while thicker ones can provide longer-lasting effect but may cause temporary blurred vision.
  • Preservatives: Some artificial tears contain preservatives to extend shelf life. Preservative-containing drops should generally not be used more than 4-6 times a day, as preservatives can irritate the eye surface with frequent use. Preservative-free artificial tears (usually found in single-use vials) are a safer option for people who require frequent use or have sensitive eyes.
  • Lipid-Based Drops: Especially in patients with Meibomian Gland Dysfunction (MGD) or evaporative dry eye, drops containing lipids (oil) may be preferred to support the deficient oily layer of the tear film and reduce evaporation.
  • Gels and Ointments: These are much thicker in consistency than drops. They provide moisturizing, especially overnight or in severe dryness, by staying on the eye surface for a longer time. However, they may temporarily blur vision after application, so their use is generally recommended before bed at night.
  • Drops Containing Sodium Hyaluronate: Sodium hyaluronate (hyaluronic acid) is a substance with high water-retention and lubricating properties. Such drops provide effective moisturization by staying on the eye surface for a long time and may be preferred in more severe dry eye cases.

Important Notes: Artificial tears temporarily alleviate symptoms but generally do not treat the underlying cause of dry eye (e.g., inflammation or MGD). If your symptoms do not improve or worsen within 72 hours, you should consult your ophthalmologist. When using drops or ointments, take care not to touch the tip of the product to your eye or any other surface to prevent contamination. If you wear contact lenses, you may need to remove your lenses before applying most drops and ointments and wait at least 15 minutes before reinserting them.

Prescription Eye Drops: Options to Reduce Inflammation and Increase Tears

In cases where artificial tears are insufficient or when more complex mechanisms such as inflammation underlie dry eye, your doctor may recommend prescription eye drops. These medications act on the underlying causes of the disease rather than just masking the symptoms. This reflects a significant shift in dry eye treatment from a symptomatic approach to a disease-modifying approach.

• Cyclosporine A Drops: Cyclosporine is an immunomodulatory drug that regulates the immune system. It helps increase natural tear production by reducing chronic inflammation on the eye surface and increasing the number of tear-producing cells (including goblet cells). It may take time for its full effect to appear; generally, at least 3-6 months of regular use is required. It is preferred in moderate and severe dry eye cases, especially when there is an underlying inflammatory process (e.g., Sjögren’s syndrome). It may have initial side effects such as mild burning in the eye. Recently, clinical studies are also being conducted on new formulations, such as ophthalmic gels containing Cyclosporine A.
• Lifitegrast Drops: Lifitegrast targets inflammation on the eye surface by inhibiting the interaction of a protein called LFA-1 (lymphocyte function-associated antigen-1), thereby inhibiting T-cell activation and migration. It can support tear production and alleviate dryness-related symptoms (burning, stinging, blurred vision). Its effect may start faster (within a few weeks) compared to Cyclosporine. Side effects such as temporary taste alteration in the mouth may occur after application.
• Corticosteroid Drops: Corticosteroids have powerful anti-inflammatory effects. They are generally used short-term (a few weeks) to rapidly suppress severe inflammation and flare-ups in the eye. They are effective in reducing the levels of inflammatory markers like MMP-9 in tears. However, because long-term and uncontrolled use can lead to serious side effects such as increased intraocular pressure (risk of glaucoma), cataract formation, and increased risk of infection, they must be used strictly under doctor’s supervision and close follow-up.
• Secretagogues (Tear Stimulants): These medications aim to increase the secretion of both aqueous tears and mucin (mucus) by stimulating the tear glands.
  • Pilocarpine: Used in oral tablet form or sometimes as drops. It can increase tear and saliva secretion, especially in severe mouth and eye dryness associated with Sjögren’s syndrome. Systemic side effects such as sweating, nausea, and frequent urination may occur.
  • Diquafosol Sodium: Stimulates P2Y2 receptors on the eye surface, promoting the secretion of both water and mucin. This helps improve both the quantity and quality of the tear film. It is approved for dry eye treatment in Japan and some other Asian countries. The most common side effects include eye irritation, eye discharge, and conjunctival redness.
  • Cevimeline: Another secretagogue taken orally and used especially in patients with Sjögren’s syndrome.
• Prescription Antibiotics: If dry eye is accompanied by eyelid inflammation (blepharitis or meibomitis), your doctor may prescribe topical antibiotics (as drops or ointment) or, in some cases, oral antibiotics to treat this condition. Some antibiotics like azithromycin or doxycycline have not only antibacterial but also anti-inflammatory and Meibomian gland function-regulating effects.

The development of prescription medications is a significant advance in dry eye treatment. These drugs aim to go beyond merely alleviating symptoms by targeting underlying issues like inflammation. New formulations like Cyclosporine gel and new classes of medications that increase mucin secretion, target Meibomian gland keratinization, or support epithelial healing (e.g., Tavilermide, AZR-MD-001, Reproxalap, currently in clinical trials) have the potential to offer more effective and personalized treatment options in the future. This dynamic research area is promising for patients.

Autologous Serum Eye Drops: Personalized Treatment

Autologous serum eye drops are a highly personalized treatment option prepared from the patient’s own blood. A blood sample taken from the patient is centrifuged, the serum part is separated, and this serum is diluted with sterile saline solution to create the eye drop form.

• Content and Effect: Autologous serum contains many biochemical components naturally found in tears (growth factors, vitamins (especially Vitamin A), antibodies, proteins like albumin, and electrolytes). These components support the healing, regeneration, and protection of the cells on the eye surface, exert an anti-inflammatory effect, and provide a much richer nourishing environment than artificial tears.
• Areas of Use: Used particularly in severe dry eye cases that do not respond to standard treatments, in serious ocular surface diseases such as Sjögren’s syndrome, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, neurotrophic keratopathy, in persistent corneal epithelial defects, and to support healing after some refractive surgeries (LASIK, PRK).
• Preparation and Use: The preparation of autologous serum drops requires special laboratory conditions and sterile techniques. They generally do not contain preservatives, so they must be stored in the refrigerator and consumed within a certain period. They can be stored longer by freezing.
• Side Effects: Since they are produced from the patient’s own blood, the risk of allergic reaction is minimal. The most significant risk is the development of infection due to contamination during the preparation, storage, or use of the drops. Therefore, great care must be taken with hygiene rules.
• Effectiveness: Some studies have shown that autologous serum drops can improve symptoms and ocular surface findings. However, a review by Cochrane indicated that while they might provide some improvement in symptoms in the short term compared to artificial tears, their overall benefit is not yet clear, and more high-quality research is needed in this area.

Step 3: Advanced In-Office Treatment Procedures

In situations where drug treatments are insufficient, or when there are underlying structural problems, such as Meibomian Gland Dysfunction (MGD), various advanced in-office procedures come into play. These procedures generally aim to provide more effective and long-lasting relief.

Punctal Plugs: Preserving Tears

Punctal plugs (or lacrimal plugs) are tiny plugs, about the size of a grain of rice, placed at the opening of the small drainage channels (puncta) through which tears drain from the eye surface into the nasal cavity.

• Purpose: These plugs help keep the eye moist by ensuring that existing natural or artificial tears remain on the eye surface for a longer period, reducing evaporation.
• Types:
  • Temporary (Dissolvable) Plugs: Made from absorbable materials like collagen and disappear on their own within a few days to a few weeks. They are usually used for testing whether permanent plugs are suitable (trial purpose) or during temporary dry periods after eye surgeries like LASIK.
  • Permanent (Semi-Permanent) Plugs: Made from durable medical materials like silicone or acrylic and can remain in place for years. They can be easily removed by a doctor if necessary. Some types are placed in the deeper part of the punctum (caniculus) and are not visible externally.
• Application: Applied quickly and painlessly by an ophthalmologist in an outpatient setting, usually with or without topical anesthetic drops.
• Who They Are Suitable For: An excellent option, especially for patients with aqueous deficient dry eye (i.e., those with low tear production) or in situations where sufficient relief cannot be achieved despite frequent use of artificial tear drops. They may also be considered in conditions like Sjögren’s syndrome or recurrent corneal erosions.
• Possible Side Effects/Risks: The most common complication is the plug spontaneously falling out of place (especially those inserted into the upper puncta). Other possible issues include excessive watering (too much tear accumulation), irritation or stinging in the eye due to the plug partially shifting, and rarely, the development of infection, inflammation (dacryocystitis), or a granuloma (small fleshy growth) in the punctum. Caution should be exercised or application avoided in those with active eye infection or severe punctal narrowing (stenosis). If there is significant inflammation on the eye surface (risk of Toxic Tear Syndrome), this inflammation may need to be treated first.

Modern Solutions for Meibomian Gland Dysfunction (MGD)

Meibomian Gland Dysfunction (MGD) is a condition where the Meibomian glands in the eyelids become blocked or the quality of the oil (meibum) they secrete deteriorates. This is the most common cause of evaporative dry eye because the protective oily layer of the tear film is inadequate, and tears evaporate quickly. Fortunately, beyond at-home warm compresses and massage, effective and modern methods are available that are performed in the office setting for MGD treatment. The widespread use of these device-based treatments is a significant advancement in MGD management and generally offers more effective and long-lasting results than traditional home care methods.

IPL (Intense Pulsed Light) Treatment

Intense Pulsed Light (IPL) treatment is a technology originally used for many years in dermatology to treat skin problems (e.g., rosacea, pigmentation) and has recently been shown to be effective in treating MGD-related dry eye.

• Mechanism of Action: The IPL device sends concentrated light pulses at specific wavelengths to the skin (usually the lower eyelid and cheek area). This light energy:
  • Closes off abnormal small blood vessels (telangiectasias) on the eyelid margin; these vessels can contribute to the release of inflammatory mediators.
  • Reduces inflammation in the Meibomian glands.
  • Increases the fluidity of solidified, thickened meibum inside the Meibomian glands by melting it with heat effect, facilitating gland expression.
  • Stimulates the function of the Meibomian glands.
  • Can help reduce the load of Demodex mites (a type of parasite) and bacteria on the skin.
• Application: Treatment is usually applied in 3-4 sessions with intervals of 3-4 weeks. Each session lasts approximately 15-20 minutes. During the procedure, the patient’s eyes are covered with special protective glasses, and a gel is applied to the skin to ensure better light transmission. After IPL pulses, the doctor may sometimes perform manual massage (expression) on the Meibomian glands.
• Benefits: Increases the quality and thickness of the tear lipid layer, prolongs the tear break-up time (TBUT), and reduces evaporation. It can provide significant relief in dry eye symptoms (improvement in OSDI and SPEED questionnaire scores), reduced need for artificial tears, and increased quality of Meibomian gland secretion and expressibility of the glands. It is particularly effective in cases of MGD associated with ocular rosacea and blepharitis.
• Patient Suitability: A good option, especially for patients with evaporative dry eye due to MGD and those with signs of telangiectasia or rosacea on the eyelids. Caution should be exercised in individuals with very dark skin tones or certain skin diseases.
• Side Effects: Generally mild and temporary. There may be a slight stinging, burning, or warmth sensation during the treatment. Temporary redness, slight swelling, and rarely small crusts or temporary changes in skin color (lightening or darkening) may be seen on the skin after the procedure. Serious side effects are very rare.
• Long-Term Efficacy and Re-treatment: The effect of IPL treatment can last from a few months to a year. Maintenance treatments (e.g., a single session every 6-12 months) may be necessary if symptoms return. Meta-analyses indicate that IPL treatment, either alone or combined with Meibomian gland expression (MGX), demonstrates superior clinical efficacy in improving MGD-related dry eye symptoms and signs and is suitable for widespread clinical use.

LipiFlow Thermal Pulsation System

LipiFlow is another important FDA-approved, in-office device used in MGD treatment.

• Mechanism of Action: The LipiFlow system uses special single-use activators that act simultaneously on the inner and outer surfaces of the eyelid. These activators apply controlled heat (approximately 42.5°C) to the inner (conjunctival) surface of the eyelid, melting the solidified meibum in the Meibomian glands. At the same time, it applies patented, vectored thermal pulsation (rhythmic, gentle squeezing and massage motions) to the outer surface of the eyelid, expelling the melted meibum from the gland channels. No direct heat or pressure is applied to the eyeball.
• Application: The procedure is usually applied as a single session and lasts about 12 minutes for each eye. After anesthetic drops are instilled, the activators are placed on the eyelids.
• Benefits: Improves the quality and quantity of Meibomian gland secretions, opens blockages in the glands, and improves tear film stability (TBUT). It can provide significant and long-lasting relief in dry eye symptoms (OSDI, SPEED scores), lasting up to 3 years in some cases.
• Patient Suitability: Suitable for patients with evaporative dry eye due to MGD, especially those detected with blockage and dysfunction in the Meibomian glands.
• Side Effects: Generally a well-tolerated procedure. Temporary mild discomfort, pressure sensation, blurred vision, redness, burning, stinging, discharge, or light sensitivity may be seen during or after the procedure. Slight swelling or irritation of the eyelid may also occur rarely. Serious side effects have not been reported, and most side effects resolve spontaneously within a short period.
• Comparative Studies and Efficacy: A Cochrane review stated that LipiFlow might provide a slight improvement in symptom scores and Meibomian gland expression scores (how easily oil comes out of the glands) at 4 weeks compared to standard warm compresses, but emphasized that the certainty of the evidence was very low. Results are mixed when compared to other thermostatic devices (e.g., TearCare, iLUX). However, a more recent and comprehensive review covering 55 clinical studies showed that a single 12-minute LipiFlow treatment safely improves the signs and symptoms of MGD and associated evaporative dry eye, and its benefits can last up to 3 years in some cases. This review also stated that patients generally find the LipiFlow treatment comfortable and that associated side effects are temporary and do not require treatment.

Other Thermal and Mechanical Treatments

• Radiofrequency (RF) Treatment: In this method, radiofrequency energy is used to gently and controllably heat the periorbital tissues (especially the eyelids). This heat helps open blockages in the Meibomian glands, increases the fluidity of meibum, and regulates gland functions. It can also improve periorbital skin health by stimulating collagen production. It is generally applied in several sessions (3-5 sessions).
• TearCare® System: This system consists of single-use heating elements that apply customizable and controlled heat externally to the eyelids. A feature of TearCare is that the patient can keep their eyes open, blink, and see during the procedure. After the heating session (approximately 15 minutes) is completed, manual massage (expression) is performed by the doctor on the Meibomian glands to clear blockages.
• iLUX® System: This is a handheld, LED-based device developed for MGD treatment. The device targets both the inner and outer surfaces of the eyelid, applying direct heat followed by doctor-controlled pressure. This melts and expels the solidified secretions in the Meibomian glands. Treatment time is usually short (a few minutes per eye, 8-12 minutes total). A clinical study by Tauber et al. compared the effectiveness of the iLUX and LipiFlow systems in MGD treatment and found that both treatments were similarly effective in improving MGD symptoms and clinical signs.
• Meibomian Gland Probing: In this method, the orifices and the channels themselves of blocked Meibomian glands are mechanically opened using a very fine, specialized probe (like a Maskin probe). It is performed under local anesthesia. It may be considered in patients with persistent blockages and those who do not respond to other treatments.
• Manual Meibomian Gland Expression (MGX): This is the procedure of carefully applying pressure to the Meibomian glands with special tools or fingers, usually after a heating process (warm compress, IPL, LipiFlow, TearCare, iLUX), to empty the accumulated, thickened meibum inside them.

Amniotic Membrane Treatment: Hope for Severe Cases

The amniotic membrane is a specially processed and sterilized biological tissue obtained from the inner layer of the human placenta (obtained after birth).

• Properties and Mechanism of Action: The amniotic membrane naturally contains various growth factors and cytokines that have anti-inflammatory, anti-fibrotic (prevents scarring), and anti-angiogenic (suppresses new vessel formation) properties. When applied to the eye surface, it accelerates the healing and regeneration of epithelial cells, reduces inflammation, relieves pain, and minimizes scar formation.
• Areas of Use: Used in severe dry eye cases resistant to other treatments, especially in conditions such as persistent corneal damage (epithelial defects), ulcers, chemical burns, Stevens-Johnson syndrome, or neurotrophic keratopathy.
• Methods of Application: The amniotic membrane can be applied stretched over a specialized contact lens-like ring or laid directly on the eye surface and secured with a bandage contact lens. It can sometimes also be sutured surgically. Application is usually performed in an outpatient setting, and the membrane may remain on the eye surface for a few days to a few weeks, during which time it slowly dissolves or is removed by the doctor.
• Benefits: Can provide a quick and significant reduction in symptoms such as burning, stinging, pain, and redness in the eye. It can significantly accelerate corneal healing and improve vision quality.